2008-181 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building &Codes (518) 761-8256
(]"E" RTIFICATE OF OCCUP-A-N- CY
Permit Number. P20080181 Date Issued: Thursday, July 17, 2008
This is to certify that work requested to be done as shown by Permit Number P20080181
has been completed.
Location: 200 LUZERNE Rd
Tax Map Number. 523400-309-009-0002-00 1-000-0000
Owner. HOMESTEAD VILLAGE L P
Applicant: HOMESTEAD VILLAGE L P
This structure may be occupied as a:
Mobile Home In Park By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Occupancy DOES NOT relieve the
property owner of the responsibility for compliance with Site Plan,
Variance, or other issues and conditions as a result of approvals by the Director of Building&Code Enforcement
Planning Board or Zoning Board of Appeals.
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20080181 Application Number. A20080181
Tax Map No: 523400-309-009-0002-001-000-0000
Permission is hereby granted to: HOMESTEAD VILLAGE L P
For property located at: 200 LUZERNE Rd
in the Town of Queensbury,to construct or place
at the above location in accordance with application together with plot plans and other information hereto filed
and approved and in compliance with the NYS Uniform Building Codes and the Queensbury Zoning
Ordinance. Tyne of Construction Value
Owner Address: HOMESTEAD VILLAGE L P
4294 ROUTE 5 Mobile Home In Park $45,000.00
CALEDONIA,NY 14423 Total value $45,000.00
Contractor or Builder's Name/ Address Electrical Inspection Agency
Plans &Specifications
2008-181
1120 sq ft mobile home-97 ALPINE
Douglas Russell
$42.20 PERMIT FEE PAID- THIS PERMIT EXPIRES: Tuesday,May 19, 2009
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the To of Qu nsb ,4 ay 19, 2008
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
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ONLY
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TAX MAP NO. PERMIT NO. DATE ISSUED:
A 1
0 PERMIT FEE `� APPROVALS: ZONING TOWN CLERK
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MOBILE HOME -APPLICATION FOR PERMIT:
A building permit must be obtained before placement of mobile home on parcel. No inspections wffl be made until a
valid building permit has been issued.
Applicant In ormation Property Owner Information
Name: I )o , � G l G S y S g Name:
Address: aO A r j i V n ham, S 1 Address:
Phone No. /�_� C1 —� �) Phone No.
arcellnformation c
Proposed Date of Placement: Property Location: I r� I ►�, / f'1
Road,Street Avenue
Name of Mobile Home Park: . (dapplicabie) Tax Map Number:
Mobile Home Information Zoning Information
Approximate Value of Home:$ Lt 0 C�� I Zoning Classification:
1
New Home: Yes No Size of Property: ft.by ft.
New Home: Yes No
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Replacement Home: es No U Existing buildings:
Size of Mobile Home: ft. by V6 ft.
side front yard ft rear yard ft.
side yards ft.and ft.
Singlewide: Doublewide:
Number of Rooms: (exclude baths) _ i Accessory Building(s): circle
Number of Bedrooms:
Number of Bathrooms; _ Detached garage: 1-car 2-car car
Circle: Gas Fireplace/Woodstove/Wood Fireplace 1 Attached garage: 1-car 2-car car
Foundation Support: Storage building: Ye No
Type Size & Depth
i Other.
Piers
Runners I Water Supply: well or rr�unlcip
Slab Is Septic Permit Required? Yes or No
i
............................. __ _._.___ _.___.._____- __ ____ _ • _.. __.._..._....._.._.__.
Continued on bads
Toznn of Queensbunj■ Comniunihj Development Office ■ 742 Bay Road, Queensaunj, iv r izcu*
Name of Installer or Mobile Home Dealer._
Address:. r, P Q( S C._r— Phone: 7 01 (Q
Complete information below found on a`Plate'or`Sticker'which is affixed to the mobile home:
✓ Insignia serial number.
✓ Name of manufacturer.
✓ Plan Approval Number.
✓ Model or Component Designation:
(New home only)
✓ Date of Manufacture:
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' AFFIDAVIT
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r Town of Queensbury State of New York Y
County of Warren x
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I swear that to the best of my knowledge and belief the c
5 statements contained in this application, together with the plans Y
and specifications submitted, are a true and complete statement
of all proposed work to be done on the described premises and
that all provisions of the BUILDING CODE, the ZONING
ORDINANCE, and all other laws pertaining to the proposed work
shall be complied with, whether specified or not, and that such
work is authorized by the owner.
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Signature:
Owner, is Agent,Architect, Contractor
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SPECIAL CONDMONS OF PERMFI
By:
ode Enforad,
'en t Officer
Town of QueensMunj• Commmnihj DevelopmeItOfficle- 742 Bay Queenshunj, NY 12804
~ OFFICE USE ONLY '
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TAX MAP NO. PERMIT NO. DATE ISSUED: i '
a
PUMIT FEE APPROVALS: ZONING TOWN CLERK ;
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MOBILE HOME -APPLICATION FOR PERMIT:
A building permit must be obtained before placement of mobile home on parcel. No inspections will be made until a
valid building permit has been issued.
Applicant Information Property Owner Information
Name.j _' 4}v)" e Z_s S�e Name: ea
Address: 2 1111)4 nE Address: L U Z e r n e
Phone No. L4 �?U - 43 3:) Phone No.
Parcel Information tt
Proposed Date of Placement,5 e Property Location: `� �j r F � V
Road,Street Avenue
Name of Mobile Home Park: ,f�U �1e S ect,d —(if app#cabie) Tax Map Number:
Mobile Home Information ' Zoning Information
Approximate Value of Home:$ Zoning Classification:
New Home: Yes No Size of Property: ft.by ft.
Replacement Home: Yes �o Existing buildings:
Size of Mobile Home: ft. by ft.
Setbacks: front yard ft. rear yard ft.
side yards ft.and ft.
Singlewide: _ Doublewide:
Number of Rooms:(exclude baths)^ - Accessory Building(s): circle
Number of Bedrooms: 3
Number of Bathrooms: �( Detached garage: 1-car 2-Car car
Circle: Gas Fireplace/���W000ddstove/Wood Fireplace Attached garage: 1-car 2-car car
Foundation Support: Storage building: Yes No
Type Size & Depth Other.
Piers
Runners Water Supply: well or municipal
Slab Is Septic Permit Required? Yes or No
....__........__........_....__....._..___.._....____ ._._ .___.__ _.._-_ ..__.._ ___—__ .__..__.__._........_........................._.........__......_.......
_...__......._---__._..---------.._.----..._.
Continued on back
Town of Queensbury• Community Development Office• 742 Bay Road, Queensoury, iv r iiaw
Name of Installer or Mobile Home Dealer.\lam
Address' � [ x.t 1�Q O F J j S Phone:
Complete information below found on a"Plate"or"Sticker"which is affixed to the mobile home:
✓ Insignia serial number.
Name of manufacturer:
✓ Plan Approval Number:
✓ Model or Component Designation:
(New home only)
✓ Date of Manufacture:
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AFFIDAVIT y
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5 Town of Queensbury State of New York
c County of Warren x
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I swear that to the best of my knowledge and belief the
statements contained in this application, together with the plans
and specifications submitted, are a true and complete statement
of all proposed work to be done on the described premises and s
that all provisions of the BUILDING CODE, the ZONING y
ORDINANCE, and all other laws pertaining to the proposed work c
shall be complied with, whether specified or not, and that such
work is authorized by the owner. y
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Signature:
c owner, Ps gent,Architect,Contractor
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SPECIAL CONDITIONS OF PERMIT
By:
Code Enforcement Officer
Town of Queenslniry• Community Development Office• 742 Bay Road, Queensbury, NY 12804
TOWN OF QUEENSBURY
�. 742 Bay Road, Queensbury, NY 12804-5902 518-761-8201
AFFIDAVIT
TOWN OF QUEENSBURY STATE OF NEW YORK
COUNTY OF WARREN
I swear that the following used mobile home that will be transported
into the Town of Queensbury for placement will have the following. A
building permit approved and issued, meet all zoning requirements,
the mobile home's HUD sticker affixed to mobile home and meet
HUD requirements for the Middle Zone. As the person responsible
for the transport and placement of this mobile home, I accept total
responsibility for removal of the mobile home from The Town of
Queensbury, if it does not meet the requirements for placement.
Signature: Date:
Mobile Home Owner, Owner's Agent, Mobile Home Contractor
Signature: Date:
Town of Queensbury Code Enforcement Officer
"HOME OF NATURAL BEAUTY . . . A GOOD PLACE TO LIVE"
SETTLED 1763
COMMONWEALTH ELECTRICAL INSPECTION SERVICE,INC.
Main Office 176 Doe Run Road-Manheim,PA 17545
MUNWIPAL CERTIFICATE ELECTRICAL APPROVAL
'A
Permit NO..
.... ... ...... 3371 Cluit-in Card No.....................................
Owner........./ e.. ... .... ..........
. ... ... ...
� . . ................
. ...............
Location.... e&4. .k. f........
.. .. . .
InstallationConsisting of.....................................................................................................................................
........................................................................................................................... f..... .........................
........................................................................................................................... .... . ...............................
InstalledBy...1541-41--e...........................................................Lic.No...................................................
The conditions following governed the issuance of this certificate,and any certificate previously issued is
cancelled:-
This certificate only covers the electrical equipment an i stallation conditions as of date. Upon the
introduction of additional equipment or alterations,applic o shall be promptly made for inspection.
Inspectors of this Company shall have the pri vIleg mak4, inspections at time, and if its
rules are violated,the Company shall have the rightto voke . certificate
Date. :71/.�/.. ............ INSPECTOR .... . ......... .. ...... ........... ........
Me er N.F.P.A.,I.A.
FINAL INSPECTION REpOVM
MOBILE / MODULAR)" `VrSk"
Town of Oueensbtlry
Building &Code Enforcement
742 Bay Road
Queensbury, NY 12804
(518) 76141256
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ARRIVED DEPART: �� P
DATE INSPE ON REQUEST RECEIVED
NAME:
LOCATION. ,
DATE: �" PERMIT/ '""
MOBILE HOME MODULAR HOW
FOOTINGS_ FOUNDA71ON _ RACKFRL_ FRAMING
N/A . YES NO
I. foundation support, pier spacing
per manuf. ........................ _ X
2. anchoring per manuf. ............... —_
3. water line shut off ................... _
4. sewer line support 0 4 feet ....... —
5. heating crossover(dblewide) off grd. ' _ —
6. dryer vented outside .x...................
7. skirting ventilated ....................
8- hot water relief valve piping outside _ —
9. deck, porches, steps. railing ........ _
10. finnace/hot water operating ........ —
11. garage fire proofing .................. —
12. door closers ........................... — —
13. plumbing fixture ...................... —
14. foundation insulation (if appi.)...... —
15. smoke detectors .. —
16. final electrical ...�.
17. variance required ............ — —
18. data plate okay ................P _ —
19. mobile HUD seal okay ..............
Model # Serial 1f
Manufacturer
Date of Manufacturer
OKAY TO ISSUE CJO YES NO
Comments:
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hive seen ce of,
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a °ail 0�gec+s such as houses,
t shnf� op, this document I aln !-,iave
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DATE
Cathec�re►-1 f1+Ct3uQICut w r�'.. N®T I C E
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ANCHORING OF MOBILE HOME
FRAME IS REQUIRED PER
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MANUFACTURERS SPECIFICATIONS
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plans and
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�OPTION&
MASTER BATH
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MODEL ERH-80F921 /3 BR,2 BATH
NOMINAL SIZE: 14' X 80' I TCD
OTAL AREA: 1,013 SQ. FT.
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